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General NPI Number Information
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NPI Number | 1912182866
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Entity Type | Organization
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Legal Business Name | R SCOTT ICKES DC INC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 55 S VALLE VERDE DR STE 450
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City | HENDERSON
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State | NV
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Zip | 89012-3110
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Country | US
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Telephone | 702-614-9500
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Fax | 702-614-9505
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Provider Business Mailing Address
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Address Line | 55 S VALLE VERDE DR STE 450
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City | HENDERSON
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State | NV
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Zip | 89012-3110
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Country | US
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Telephone | 702-614-9500
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Fax | 702-614-9505
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD SCOTT ICKES
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Credential | DC
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Telephone | 702-614-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B725
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License Number State | NV
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